Whether revisions to the bible of mental illness should be carried out in secret might seem like an academic question.
But the issue carries real weight for parents desperate to address children's difficult behavior or people in distress over their mental state. It also speaks to citizens' concerns over news accounts of an overmedicated America and of the troubling financial links between some psychiatric researchers and the pharmaceutical industry.
An update is underway for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, known as the DSM, which defines the emotional problems for which doctors prescribe drugs and insurance companies pay the treatment bills. Psychiatrists working on the new edition were required to sign a strict confidentiality agreement.
Critics contend that the American Psychiatric Assn. should allow outside observers to review the scientific debate behind new and revised diagnoses.
Among the most prominent to speak out is the editor of the manual's third edition, Dr. Robert Spitzer, hailed by peers as the most influential psychiatrist of his generation. If the DSM is often called the profession's bible, then the DSM-III is the King James Version. Released in 1980, it set the standard by which others are measured.
Recently, Spitzer broke ranks by publishing an open letter to the profession protesting the confidentiality mandate.
"If you don't know what goes on at someone's meetings, they're suspect of having a conflict of interest," the Columbia University professor said in an interview.
The profession is already confronting that issue through revelations that academics in the field are earning tens of thousands of dollars in consulting fees from drug companies. The financial links between the drug industry and the psychiatric community have sparked a congressional investigation headed by Sen. Charles E. Grassley (R-Iowa).
Officials with the APA counter that the psychiatrists working on the DSM revision are limited to $10,000 annually in fees from drug companies. The association says "transparency" is the byword of those overseeing the process.
Darrel Regier, who heads the APA's research arm, said the critics are failing to recognize progress in the field. "The field of psychiatry has gone from an ideology to a scientific pursuit," he said. The DSM grew out of a guidebook used by the military during World War II. Afterward, it was revised for general use and subsequently enlarged.
